Can a COVID Infection Harm Your Heart?

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy.

Stanley Hazen, MD, PhD:

My name is Stanley Hazen. I'm the Co-Section Head of Preventive Cardiology and Cardiac Rehabilitation at Cleveland Clinic. My interests are in trying to identify novel contributors to cardiovascular disease, in particular beyond the traditional risk factors for a heart attack or stroke, so beyond cholesterol, blood pressure, diabetes, weight, exercise. We know that if you treat all of those things, still the majority of events continue to happen. So we know that there are additional pathways and processes that contribute to residual cardiovascular risk. One of the things that we've noticed clinically over the last few years is that there's a surprising increase in the number of heart attacks and strokes that are happening to younger people. Part of this brought us to the interest in trying to study what the impact of COVID is on cardiac health. Because early on, we saw that patients who experienced COVID and were hospitalized for COVID had a higher incidence of thrombotic events in the hospital like heart attack and stroke.

In our study, we looked at the UK Biobank. This is a cohort of subjects in the United Kingdom that were enrolled in 2000 and followed over time. Because they had very good access to whether or not the subjects in the cohort, and this is over a quarter of a million people, had experienced COVID and had a PCR-positive COVID test, we could leverage use of this database to ask questions like for those individuals amongst the quarter of a million who experienced a positive COVID test, what was their risk for then experiencing, subsequent to COVID, a heart attack, stroke or death? Now, at the time that we began our studies, it had already been published that in the near term, that is in the one month or up to three month range after experiencing COVID, one saw an increase in the risk of heart attack and stroke, but long-term risk for cardiovascular events following a COVID infection had not been reported.

So using UK Biobank and approximately a quarter of a million subjects, we looked at the data set and saw that individuals who just had a PCR-positive COVID test, this is before vaccinations were given out, so in the year 2020, and out of a quarter million people enrolled, we had thousands of COVID-positive subjects. And then amongst those, there was at least a twofold increased risk for heart attack, stroke or death over the ensuing period of follow-up. So that was up to three years of follow-up now available. So in the years 2021, 2022 and 2023, we saw a doubling in the risk of heart attack, stroke and death.

Now, the subjects that we're looking at are all 50 and older, and it's a community-based cohort, and we saw that this increase in risk was independent of traditional risk factors. So whether or not the subjects had high blood pressure or diabetes or high cholesterol really did not impact the risk for heightened cardiovascular event. The increased risk was seen predominantly in thrombotic events like heart attack and stroke. Another thing that was quite surprising is that if we looked at the trajectory of the increase in risk, it did not attenuate over time. What I mean by that is in the first year after the COVID infection versus the second year or even waiting to look only between year two and year three, in that third year, there still was the same increase in risk observed. So something about COVID seems to be rewiring and making them more prone to developing cardiovascular events in the future.

Another thing that we looked at is what is the impact of severity of disease on the risk for a heart attack, stroke or death following a COVID infection? So we used severe COVID as defined by being hospitalized for COVID as an indication for the hospitalization. We found that patients who had severe COVID were at even higher risk, somewhere between four and seven-fold risk. So the severity of the COVID infection seems to result in a long-lasting effect on long-term cardiac risk. The magnitude of that increase in risk following severe COVID infection was comparable in magnitude to a coronary artery disease risk equivalent. What we mean by that is if someone who had coronary artery disease or a heart attack, their risk for a second heart attack is the same risk as a patient who had never had documented coronary artery disease or cardiovascular disease and they experienced severe COVID. What their risk for experiencing a cardiovascular event was is the same as if someone who had no COVID and had one heart attack, what their risk is for the next heart attack.

Announcer:

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